@article {Sandvike84, author = {Hogne Sandvik and {\O}ystein Hetlevik and Jesper Blinkenberg and Steinar Hunskaar}, title = {Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway}, volume = {72}, number = {715}, pages = {e84--e90}, year = {2022}, doi = {10.3399/BJGP.2021.0340}, publisher = {Royal College of General Practitioners}, abstract = {Background Continuity, usually considered a quality aspect of primary care, is under pressure in Norway, and elsewhere.Aim To analyse the association between longitudinal continuity with a named regular general practitioner (RGP) and use of out-of-hours (OOH) services, acute hospital admission, and mortality.Design and setting Registry-based observational study in Norway covering 4 552 978 Norwegians listed with their RGPs.Method Duration of RGP{\textendash}patient relationship was used as explanatory variable for the use of OOH services, acute hospital admission, and mortality in 2018. Several patient-related and RGP-related covariates were included in the analyses by individual linking to high-quality national registries. Duration of RGP{\textendash}patient relationship was categorised as 1, 2{\textendash}3, 4{\textendash}5, 6{\textendash}10, 11{\textendash}15, or \>15 years. Results are given as adjusted odds ratio (OR) with 95\% confidence intervals (CI) resulting from multilevel logistic regression analyses.Results Compared with a 1-year RGP{\textendash}patient relationship, the OR for use of OOH services decreased gradually from 0.87 (95\% CI = 0.86 to 0.88) after 2{\textendash}3 years{\textquoteright} duration to 0.70 (95\% CI = 0.69 to 0.71) after \>15 years. OR for acute hospital admission decreased gradually from 0.88 (95\% CI = 0.86 to 0.90) after 2{\textendash}3 years{\textquoteright} duration to 0.72 (95\% CI = 0.70 to 0.73) after \>15 years. OR for dying decreased gradually from 0.92 (95\% CI = 0.86 to 0.98) after 2{\textendash}3 years{\textquoteright} duration, to 0.75 (95\% CI = 0.70 to 0.80) after an RGP{\textendash}patient relationship of \>15 years.Conclusion Length of RGP{\textendash}patient relationship is significantly associated with lower use of OOH services, fewer acute hospital admissions, and lower mortality. The presence of a dose{\textendash}response relationship between continuity and these outcomes indicates that the associations are causal.}, issn = {0960-1643}, URL = {https://bjgp.org/content/72/715/e84}, eprint = {https://bjgp.org/content/72/715/e84.full.pdf}, journal = {British Journal of General Practice} }